Background: Recent breakthroughs in antiretroviral (ARV)-based prevention provide new opportunities to rethink HIV prevention strategies, especially for key populations such as female sex workers (FSWs). As pre-exposure prophylaxis (PrEP) demonstration projects are increasingly initiated, more information is needed about the correlates of PrEP retention when implemented in Ministry of Health (MoH)-run clinics such as in Senegal.
Methods: The Senegal PrEP Demonstration Project is a prospective, open-label cohort study assessing the delivery of oral Truvada (emtricitabine/tenofovir DF) PrEP to FSWs in 4 Ministry of Health (MoH)-run clinics in Dakar, Senegal. We assessed retention in PrEP care at 6 and 12-months follow-up. Repeated measures analysis using Generalized Estimating Equation (GEE) models were used to identify the predictors of PrEP retention.
Results: Overall, out of 325 eligible FSWs, 271 (83.4%) were initially enrolled at baseline. The average age of those enrolled was 38 years (STD=8.7). Most FSWs were Senegalese (96.7%), and approximately half of them never attended school (44.8%). Among the 267 participants who were prescribed PrEP, 70.4% were retained in care at six months (Pikine: 68.5%, Mbao: 78.8%, Rufisque: 71.2%, Diamniadio: 65.8%; p=0.439) and 67% were retained in PrEP care at twelve months (Pikine: 69.9%, Mbao: 61.5%, Rufisque: 72.7%, Diamniadio: 63.2%; p=0.483). Older age among FSW was found to be a significant predictor of higher PrEP retention (P = 0.0012). Compared to the 18-24 year age group, the 25-34 (OR= 2.53, 95%CI=1.22-4.99), 35-44 (OR= 3.24, 95%CI=1.57-6.23), and 45+ year age groups (OR= 3.85, 95%CI=2.13-10.27) were significantly more likely to be retained in PrEP. We did not find significant differences in retention by site, education, registration as sex worker status, condom use or HIV risk perception.
Conclusions: Our results showed evidence of good PrEP retention rates among FSWs at 12-months follow-up when offered in Ministry of Health (MoH)-run clinics in Dakar, Senegal, with older age as the only significant predictor of higher PrEP retention. Further research is needed to identify the factors that may optimize retention in PrEP care in public health settings.